About

Marie Boltz is the Associate Dean for Research and Innovation and the Elouise Ross Eberly and Robert Eberly Endowed Professor in the Ross and Carol Nese College of Nursing at Penn State. She is an internationally recognized gerontological nurse scientist whose research focuses on improving outcomes for older adults living with dementia across acute care, long-term care, and community settings. Boltz’s program of research emphasizes promoting function in older adults, caregiver efficacy and support, dementia-capable health systems, rural health, community-engaged research, and implementation science to translate evidence into practice. She has served as principal investigator or co-investigator on numerous federally funded studies supported by the National Institutes of Health, Agency for Healthcare Research and Quality, Patient-Centered Outcomes Research Institute, and the Alzheimer’s Association. Her work has resulted in sustained improvements in care delivery, patient engagement, and quality outcomes for older adults and their care partners. A Fellow of the American Academy of Nursing and the Gerontological Society of America, Boltz has received multiple national awards recognizing her contributions to gerontological nursing research, education, and leadership. She is deeply committed to interdisciplinary collaboration, mentorship of early-career investigators, and advancing innovative research that informs policy and practice.

Research topics

• Medicine
• Psychology
• Nursing
• Gerontology
• Physical therapy

Selected publications

• Care Partner and Care-Receiver Kinship Influences Desire to Seek Long-Term Care After Hospitalization

  Innovation in Aging · 2025-12-01

  articleOpen accessSenior author

  Abstract Dementia affects 57 million people worldwide, and over 7 million Americans live with Alzheimer’s disease. Care partners play vital roles in providing care, but they also express several stressors, including behavioral symptoms, relationship stressors, and preparedness. There is evidence that the kinship (type of relationship) and quality of the care partner/care-receiver relationship are related to long-term care placement and quality of life. However, limited research has examined how kinship influences the desire to seek long-term care, post-acute hospitalization. This secondary analysis of a cluster randomized clinical trial (Family-centered Function-focused Care) examined the association between kinship and desire to seek long-term care for person with dementia at discharge, 2 months, and 6 months post-acute-hospitalization by care partners of hospitalized patients with dementia (N = 158). Care partner kinship type was classified as spouse/partner (n = 47), adult child (n = 86), or other relatives/friends (n = 25). Findings showed significant main effects of kinship type with a desire to seek long-term care [discharge covariates: F(2,158)=4.80, p=.010, partial-η²=.061; 2-month: F(2,145)=4.54, p=.012, partial-η²=.059; 6-month: F(2,145)=4.21, p=.017, partial-η²=.055] . Spouse/partner care partners showed lower desire to seek long-term care compared to adult children across timepoints (discharge: M = 0.96 vs. 1.34, p=.019; 2-month: M = 0.91 vs. 1.57, p=.013; 6-month: M = 0.66 vs. 1.55, p=.013) and others at 6-months (p=.002). Significantly older care partner age across all timepoints (p=.012, p=.004, p=.009), higher neuropsychiatric symptoms (p=.024), and lower care partner preparedness (p=.030) were associated with desire to seek long-term care. Our findings support interventions targeted at the care partner-recipient kinship type, aiming at preparedness and behavioral symptom management.

  PublisherOA PDFDOI

• Evaluating Pain Management Competency in Dementia via Virtual Simulations: Research Implications

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Pain under-recognition in dementia highlights the importance of clinicians’ pain management competencies in improving care for this population. Virtual simulation presents a potentially more efficient alternative to direct observation for competency evaluation. Simulation allows clinicians to review patient histories, ask questions, perform assessments, and administer treatments on mock cases with interactive responses based on pre-designed scenarios. However, virtual simulation has not been extensively used in dementia pain management research. This study reports the challenges and strategies in using virtual simulations to evaluate nurses’ pain management competencies for nursing home residents with dementia. Three scenarios, each representing different dementia stages and pain characteristics, were developed in collaboration with a technology company. The competency evaluation involves two steps. First, after viewing an orientation video, nurses performed pain management on two randomly assigned scenarios. Second, raters reviewed the simulation reports and assessed competencies using the Pain Competency Evaluation in Dementia Scale. Seventeen nurses/nursing students participated, with an average age of 25 years (94% female) and pain competency score of 66%. Challenges included participating nurses improperly exiting the simulation, resulting in unsaved reports. Raters encountered errors in simulation reports. These issues were addressed with the technology company. Scenario development took five months, involving scripting, validation, and refinement. Limitations included difficulties in showing subtle facial expressions and word limits in medical records. Subtle expressions were converted into words, and text was condensed in medical records. Future research should consider the benefits and limitations of virtual simulation while ensuring the design is optimized for research objectives.

  PublisherOA PDFDOI

• Internationally Educated Nurses' Experiences of Working in U.S. Long‐Term Care Settings

  Research in Nursing & Health · 2025-11-30

  articleOpen access

  Increasing reliance on Internationally Educated Nurses (IENs) in the U.S. healthcare system, particularly in Long-Term Care (LTC) settings, necessitates an in-depth exploration of their transition experiences. The primary purpose of this qualitative study was to understand how IENs describe their experiences transitioning to work with older adults in LTC settings in the United States and the policies and practices that contribute to the successful integration of IENs. A qualitative descriptive design was used, including one-time individual interviews with 22 IENs working in various LTC settings across the United States via Zoom using a semi-structured interview guide. Demographic data were analyzed using descriptive statistics, while NVivo 14 software was utilized to organize the data; verified verbatim transcripts were subjected to thematic analysis. Three key themes were identified: Systemic and Practice-Based Barriers to IEN Integration, Structural and Social Enablers of IEN Integration, and Role of Structured Support Systems in the IENs' Transition. This study highlighted the critical challenges and facilitators that influence IENs during their integration into LTC settings in the United States. Participants reported concerns, specifically noting experiences of racial discrimination and xenophobia perpetrated by co-workers, patients, and patients' families. These experiences highlight the complex interpersonal dynamics faced by IENs, underscoring the need for proactive strategies to mitigate discriminatory practices and provide culturally sensitive orientation and mentorship programs to support the smooth integration of IENs into LTC settings. Addressing these challenges can have profound implications for strengthening inclusivity and enhancing the overall resilience of the U.S. nursing workforce, particularly within LTC environments.

  PublisherOA PDFDOI

• DIGNITY: Initial Manual and Tool Development With Community Advisory Board

  Innovation in Aging · 2025-12-01

  articleOpen accessSenior author

  Abstract Successful translation of scientific discoveries into health improvements requires community involvement in all research stages. Recruiting nursing home (NH) stakeholders has been challenging due to systemic issues highlighted during the COVID-19 pandemic. This project leverages existing NH community stakeholders to co-develop the DIGNITY program for future testing. A community advisory board (CAB) of NH stakeholders was established using purposive sampling. Semi-structured sequential focus groups collected stakeholder opinions on the development, refinement, implementation, and evaluation of the DIGNITY program for rural NH environments. Stakeholders completed a demographic survey and reviewed the drafted DIGNITY program intervention manual. Fourteen NH stakeholders, including academic and clinical experts (n = 5), NH administrators/leaders (n = 3), direct care workers (n = 2), regulators (n = 1), and ombudsman (n = 3), participated in four focus group sessions between October and December 2022. Qualitative content analysis of transcript data indicated that stakeholders found the DIGNITY program relevant and feasible for assisting rural NH staff in honoring residents’ risky preferences for care and activities. Stakeholders identified programmatic areas for modification within six themes: (1) DIGNITY manual formatting, (2) communication, (3) expanding staff roles, (4) addressing residents’ decision-making capacity, (5) potential barriers to implementation, and (6) potential facilitators to implementation. Discussions with stakeholders indicated a need to involve other key stakeholders in rural areas, including residents, family members, direct-care staff, and regulators, in the initial development of DIGNITY. Presented by a participating physician clinician, the discussion will provide a pragmatic participatory lens for improvements made to the DIGNITY program.

  PublisherOA PDFDOI

• Clinical Factors Mediating Physical Function and Participation in Function Focused Care Among Hospitalized Persons With Dementia

  Alzheimer Disease & Associated Disorders · 2025-10-01

  articleSenior author

  BACKGROUND: Function Focused Care (FFC) encourages mobility during hospitalization, but participation varies. This study examined whether cognitive function, delirium severity, behavioral symptoms, and pain mediate the relationship between physical function and FFC participation. METHODS: Discharge data from the FFC for the acute care trial (N=428) were analyzed. Physical function was the independent variable, FFC participation the outcome, and cognitive function, delirium severity, behavioral symptoms, and pain were tested as potential mediators. A multiple mediation model assessed indirect effects. RESULTS: Indirect effects through cognitive function (B=0.125, 95% CI [0.064-0.184]) and delirium severity (B=0.110, 95% CI [0.052- 0.168]) were significant, accounting for 24.5% and 21.6% of the total effect, respectively. Indirect effects through behavioral symptoms and pain were not significant. CONCLUSION: Findings highlight cognitive function and delirium severity as key factors influencing FFC participation during hospitalization, underscoring the importance of tailoring strategies to enhance engagement in mobility-focused interventions among persons living with dementia.

  PublisherDOI

• Transfer of Knowledge and Academic-Practice Partnership in Nursing Homes - International Experiences

  Innovation in Aging · 2025-12-01

  articleOpen accessSenior author

  Abstract Nursing homes are not only places where people in need of care are cared for, they are also increasingly seen as places of partnership between academia and practice and places of knowledge transfer. They offer practical approaches to skills development and lifelong learning for staff, promote research capacity and improve outcomes for residents. This requires continuous organizational development, the expansion of digitalization potential, the training of specialized geriatric staff and the integration of evidence-based, person-centred care into the operation of nursing homes. Academic-Practice Partnership models are therefore gaining increasingly attention as a feasible approach to achieve these goals. This symposium will describe interdisciplinary collaboration between scientists, care providers and educators in nursing homes in four countries: United States, Germany, the Netherlands, and the Austria. Experiences of stakeholders, research activities and the evaluation and implementation of digital services will be discussed. The first presentation will presentation will provide an overview of the Dutch Living Lab in Long-term care. The second presentation will describe interdisciplinary staff’s experiences and the impact of Age-Friendly Care 4M Rounding with older adults living in long-term care. The third presentation will highlight the collaborative development and implementation of a practice-oriented, evidence-based toolkit for non-pharmacological pain management within the nursing home environment of the Austrian living lab. The final presentation will describe the TCALL project in Germany, with a focus on implementing innovative digital tools into daily practice. A discussion will follow addressing future directions and challenges of academic-practice partnership in nursing homes including policy implications.

  PublisherOA PDFDOI

• Optimizing Dementia Care Interactions With the QUALity of Interactions Inventory (QUALII)

  Innovation in Aging · 2025-12-01

  articleOpen accessSenior author

  Abstract To optimize daily care interactions and enhance quality of care and quality of life of residents with dementia, a comprehensive measure is needed that can guide the desired practice of positive care interactions and evaluate the impact of practice. Such a comprehensive measure of staff-resident interactions in dementia care in assisted living (AL) settings is lacking. Thus, we developed the QUALity of Interactions Inventory (QUALII)— a five domain 21-item comprehensive tool with items representing approaches to positive care interaction in dementia care in AL. This study aims to describe the development and refinement of QUALII. QUALII was developed based on communication theory and the review of the literature. It was revised with input from a panel of N = 10 clinical and academic experts in dementia care and communication utilizing the Delphi survey approach. Following three rounds of Delphi survey, the five domain 21-item QUALII was reduced to a five domain 19-item tool. The revised QUALII demonstrated good content validity based on Content Validity Index (CVI) of individual items (Item relevance I-CVI range= 0.90 to 1.00; Item clarity I-CVI range= 0.80 to 1.00) and the overall scale (S-CVI Average= 0.93). The tool’s theoretical foundation, evidence base, and demonstration of content validity suggests its significant potential to guide and evaluate positive care interactions in dementia care and warrants further psychometric testing.

  PublisherOA PDFDOI

• Age-Friendly and Climate Ready? The Importance of Climate Change to Age-Friendly Transformations

  Innovation in Aging · 2025-12-01

  articleOpen accessSenior author

  Abstract Significant investments in Age-Friendly initiatives demonstrate a growing social commitment to reducing ageism and enhancing quality of life for older adults. Exposure to the health impacts of climate change place older adults living alone at high risk for suffering and mortality. The purpose of this qualitative study was to explore perceptions of the natural environment (importance and concern) and preparation for extreme weather events across the age-spectrum. Researchers in a college of nursing partnered with a mobile clinic and attended eight events in five rural communities. We conducted 41 in-person face-to-face semi-structured interviews with randomly selected participants. Iterative thematic analysis resulted in six major themes: Importance of the Natural Environment, Concerns about the Natural Environment, Experiences with Extreme Weather, Preparing for Weather Emergencies, Sharing and Acts of Care, and Causes and Control. Findings illustrate 1) continuity in the value placed on the natural environment across the age-spectrum, 2) a common perception that “others don’t care enough”, and 3) a desire to share knowledge. Findings can be applied to Age-Friendly initiatives to promote shared benefits of healthy environments, address the misperception that no one cares to help normalize conversations about climate change and preparedness, and provide opportunities for age-integration through program activities, civic events, and the built environment. Integrating climate change into Age-Friendly movements is necessary to keep older adults safe, healthy, and thriving, but also to promote age-integration as a powerful mechanism for building strong communities capable of caring for one another during climate-related disasters.

  PublisherOA PDFDOI

• Implementation of Function-Focused Care in the Hospital Setting: Results of the FFC-AC-EIT Trial

  Innovation in Aging · 2025-12-01

  articleOpen accessSenior author

  Abstract Once hospitalized, individuals living with dementia are more likely to experience negative impacts of hospitalization including a decline in physical activity, function, falls, delirium, and behavioral symptoms associated with dementia, when compared to individuals without cognitive impairment. The Function Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT) intervention, in contrast to structured exercise or mobility programs, helps nurses engage patients in routine care activities and therefore provides a more realistic and sustainable approach to increase function and physical activity. The FFC-AC-EIT intervention was implemented by a nurse interventionist working with a unit-based interdisciplinary stakeholder team and champion using a four step approach: environment and policy assessment; education of staff, patients, and families; development of function-focused care goals; and mentoring and motivating the staff, patients, and families. A clustered randomized design was used with 12 hospitals randomized to FFC-AC-EIT versus Education Only. This symposium reports the main outcomes of the FFC-AC-EIT trial, as well as other relevant, secondary analyses that provide insights into factors to consider when implementing and evaluating FFC-AC-EIT. The first and second presenters will report the primary and secondary outcomes of the trial, respectively. The third presenter will discuss the impact of delirium upon our major outcome, physical function, in a sample of older adults with dementia. Finally, the fourth presenter will describe the association between patient engagement and the quality of staff-patient interactions.

  PublisherOA PDFDOI

• Smart Ambient Bright Light for Nursing Home Residents With Dementia: Neurobehavioral Symptom Impact

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Most nursing home (NH) residents with dementia experience neurobehavioral symptoms. Lighting interventions have shown some positive impact on these symptoms, yet most interventions have not incorporated natural daylight. This study developed the Smart Ambient Bright Light (SABL) and evaluated its effect on neurobehavioral symptoms in nursing home residents with dementia. The SABL is an automatic lighting system that incorporates natural daylight and delivers bright light (high circadian stimulation [CS] and light intensity [lux] levels) during the day and dim light (low CS and lux) during the night. This 13-week crossover, cluster randomized controlled trial enrolled 27 residents with dementia and agitation in two Pennsylvania NHs. Neurobehavioral symptoms were measured biweekly using the Neuropsychiatry Inventory (NPI). Participants’ individual lighting exposures (CS and lux) were measured using an individual wearable light sensor clipped on their collar/shoulder all day, 7 days a week, every other week. Participants were 87.4 years old on average and primarily female (74%). Controlling for age, gender, and dementia stage, participants had significant reductions in appetite, depression, and nighttime behaviors during the intervention as compared to control periods. All other neurobehavioral symptoms also showed positive trends but did not reach significance. The lighting effect, based on individual lighting exposure, showed that higher daytime CS and intensity (lux) levels were significantly associated with lower apathy, appetite changes, delusions, and hallucinations. Individual CS levels were also significantly associated with fewer nighttime behaviors. Findings suggest that the SABL intervention has a positive effect on reducing neurobehavioral symptoms in NH residents with dementia.

  PublisherOA PDFDOI

Recent grants

• Testing the Efficacy of FFC-AC-EIT in Patients with Alzheimers Disease and Related Dementias

  NIH · $2.4M · 2020–2024

• Reducing Disability via a Family-centered Intervention for Acutely-ill Persons with Alzheimer's Disease and Related Dementias

  NIH · $2.8M · 2017–2023

Frequent coauthors

• Jos A. Bosch

  288 shared

• Elizabeth Galik

  241 shared

• Nicolas Rohleder

  Friedrich-Alexander-Universität Erlangen-Nürnberg

  216 shared

• Shin Fukudo

  Tohoku University

  216 shared

• Yoshiyuki Takimoto

  The University of Tokyo

  216 shared

• Holly Rau

  VA Puget Sound Health Care System

  214 shared

• Paula Williams

  PTC Therapeutics (United States)

  208 shared

• J. Rick Turner

  IQVIA (United States)

  202 shared

Awards & honors

• Nightingale Award for Nursing Research (2022)
• Distinguished Gerontological Nurse Educator, National Hartfo…
• Doris Schwartz Gerontological Nursing Research Award, Geront…